To all my faithful readers... I cant imagine there are many of you left out there.
Just a quick hello and "see you later" (not exactly goodbye).
Blogging is just not happening in the midst of my busy life right now, and Im "giving up" on it for now.
I appreciate all the thoughts, feedback, and smiles youve provided. I hope to check in on your blogs when I get a chance... youve always been a source of inspiration and encouragement.
So, for now, hasta luego!

If there has been a lack of writing as of late, it hasnt been for lack of things to say, just the time in which to put the words to "paper" (or screen, as it were).
Status: MIA
Hope to be back in full force soon.

Spring fever. Gone.
Winter. Back.
I feel like hibernating all over again.
************
My mind is a bit fuzzy... sleep deprivation will do that to you.
Working nights is hard on the body, but theres no doubt that the first night back is the hardest. I know some who nap before coming in that first night, but my body just wont do it. I try to sleep in for a couple of hours the morning before because that seems to help a bit, but theres nothing quite like being up all day and then expected to function on a highly-skilled nursing level all night as well. To those patients who are sad to see me go, anxious that the next nurse will be a different personality, I am quick to point out, "I am a waste of space after 7:00am... you really wouldnt _want_ me here!" My brain clocks out before my hands can fumble through the motion of swiping my tag.
A few night-shift survival mechanisms that have helped me to make it through:
1. Sleep when you can on your days off... your body will thank you! Sometimes its hard to switch back and get to bed at a reasonable hour when youre coming off a string of nights, but it makes a difference in the long run.
2. Get regular exercise on your days off... being in good shape is a huge boost, your energy level will be higher all the time.
3. Bring something to munch on in the car on the way home. That drive can be a killer. Literally. For some reason, having something in my mouth keeps my eyelids open.
4. Dont rely too much on caffeine. Ive done it both ways, and my body seems to regulate between sleep and awake much more efficiently without. Cant seem to give up that one last cup of coffee... but Ive lived on as many as 8-10 cups a day. Say it with me, "Mod-er-a-tion."
5. Its ok to use a sleep aid once in a while, and for some of us, a little Tylenol PM or Benadryl will do the trick. If youre an Ambien advocate, so be it. Just try not to get hooked! And be aware that you may feel a little groggy when waking. Its never been bad for me, and sometimes what I really need is the good, solid (vs. restless, dream-filled) sleep provided with a little medicinal assistance.
6. Im all about the old-fashioned ear plugs and room-darkening shades. Some people cant stand the feeling of the plugs in their ears, but with boisterous children in the house, I find theyre invaluable. And a dark room is awesome, almost tricks your body into believing it IS night-time (key word, _almost_).
7. Give it time. Eventually youll get used to those bags under your eyes, and the dull throbbing at the base of your skull. People will stop asking if youre ok, because now its just the way you look. Its alright... youre a night-shifter... and night people RULE!
Or at least we like to think so, in our delirious, sleeping-while-sitting-up state.
Zzzzzzzzzzzzzzzzzzzzzzz

Despite the fact that we have snow predicted for Thursday, today is a beautiful tease, a happy reminder that inevitably the snow WILL melt, the juncos will scatter to the north, and the robins will return.

Thank goodness for sunshine!

*****

Its an odd world that we inhabit as hospital nurses, particularly on night shift.

Surrounded by concrete walls, ensconced in darkness, our shifts are marked by activity and change, nonetheless. We take vitals, listen to lung sounds, page doctors, deliver babies, regardless of the outside world and irrespective of the late hour.

Usually, we have a vague sense of whats happening outside as the few patients and doctors come and go, remarking upon significant events or weather phenomena. But there are also times when we walk through the hospital doors at the end of a shift, only to find a dense fog, a new layer of snow, a howling wind. The quiet corridors and dim rooms dont always belie these changes, as they have no bearing on what happens within.

Just a thought, as I sit here and soak up the luscious new warmth. My friends who are working today have no sense of this bright sky, this gentle breeze. How strange to think that if I were there, or were sleeping between shifts today, I, too, would have missed out on this brief glimpse of spring coming.

Snow drifts on the ground.
My breath hangs uncertainly in the frigid air.
Winter still. Stubborn.
But as I drove to work in the warm cocoon of my car, I was transformed by a vision of bright rows of lights, shining festively through the transparent walls of a greenhouse at one of the nurseries I pass by.
Instantly invigorated!
I imagine the vibrant lights perched above tiny seedlings, coaxing them to grow despite the lingering reality of winter outside their sheltered walls.
And as the birdsongs further testify this morning, spring is coming.
They know it.
And I am hopeful again.
******
I enjoy working at a teaching hospital. Really.
However.
It can be extremely, astoundingly, incomprehensibly frustrating when the team of residents on call are a bunch of indecisive know-it-alls. Sounds contradictory, right? Maybe thats why the plan of care for my clinic patient (whose care is overseen by the residents) changed every 5 minutes or so last night. They all know it ALL and are ALL making the decision.
Draw labs at 0500.
(talk to senior resident)
Cancel that, lets recheck them stat.
Straight cath her.
(discuss with attending)
Actually, now that you just cathd her, I think were gonna need a foley.
Lets hold off on the Mag.
(enter senior resident)
Pressures up but well just keep a close eye on it. And better draw those labs again.
(update chief again)
Now we are starting Mag. And antibiotics.
And some rectal Tylenol.
And I think shes gonna need a section.
(review with attending)
Yeah, lets just do the C-section now.
Hold that thought, the other clinic patient needs a section, too. This one can wait an hour.
*** hour goes by while I furiously try to catch up with meds and charting and explain to family why, despite the fact that the decision has been made, we cant do the C-section right now***
(re-enter senior resident)
Lets go, were ready NOW!
Intersperse numerous cervical exams by whichever resident is around at the time, and you may have a potential cause for the chorio.
Argh.
Baby did great, and the patient came through it all okay.
The nurse, on the other hand, feels defeated and sad. For the patient, for herself, and for a system that could clearly be better.

Once again, Change of Shift is up at Emergiblog...
Im headed over there for some gread reads!
Maybe one of these days Ill come up with something worth submitting.

Gearing up for another weekend.
Thinking, "I must be a sprinter."
Life is cyclical, and everything in my life seems to rotate through short bursts of activity.
This week, working out.
Last week, housecleaning.
Before that, writing.
Dieting.
Keeping in touch with friends.
Knitting.
Photography.
Some weeks (a lot of them during these dark winter months), I cant seem to accomplish or keep up with any of it.
I dont have the stamina to sustain any one of my endeavors consistently in the long run. I am not a long-distance runner. I dont know how some people do it.
They must drink a lot more coffee than I do.
I know what my constant is: procrastination. Im an expert, and that one never fails me.
We all have our talents, right?

Here I am, after taking some of my fellow bloggers fabulous advice, straight off the treadmill, riding high on workout endorphins (and not a little lactic acid!)... burn out? Me??? Never!
Well, okay. Im trying.
This nursing thing is a roller coaster. A lot like life in general. Good days, bad days. I try not to carry too much of it with me, but apparently am not completely successful in this endeavor. The work dreams are not a rarity. They happen almost every weekend, and occasionally during the week. Im hoping theyre just my minds way of decompressing.
On the one hand, nursing is a great career. Talk about job stability. Theyre practically beating down our doors to offer jobs to qualified nurses! Ill always have multiple avenues of practice available if I become unsatisfied with the work that I do now. And I still look forward to most of my shifts, have a sense of camaraderie with my coworkers, enjoy the way my schedule works with my life (most of the time), and am forever in awe of the breathtaking moments my job allows me to witness.
But there are other moments, too. Anyone who has read my blog before can attest to the heavy amount of skepticism I hold for the hospital establishment and the system in general. Paperwork and charting are significantly overvalued in a legalistic atmosphere that reeks of the fear of liability and malpractice. Night shift is great, but my body does not always agree... Ive become accustomed to a certain amount of fatigue and fuzziness that never really goes away. And on... and on...
So what, you say?
Nothin really... these were just a few of my thoughts while burning calories and trying not to burn out.

Vivid dreams of a terrible shift... working, working. So busy, patients everywhere, bad heart tones in every room. I must have been in charge... I found myself running from one room to the next, putting out fires, starting IVs, calling docs. Remember struggling for a while with IV lines that were hopelessly tangled, and not compatible with our pumps, so I must have dug up an ancient pump from somewhere and figured out how to get the IV running and attached to a pole. Ran to another room to help with an IV, and a newer nurse was poking her with a 20 gauge... thinking, "What are you doing?! We need an 18 gauge!"
In the midst of it all, my kids were there with me, except it was my friends kids, but they were mine, and the baby was so small, and I had to hold him while he slept. It really pulled at my heartstrings as the chaos swarmed around us.
So strange.
And I havent even worked my first night this week.

Fabulous!
/jo and Kim have both posted their *must-have* lists, and tagged a few of my other favorite bloggers...
This meme is proving to be an interesting glimpse inside other nurses heads.
How do you come up with the four things you really think you cant live without?
Where do you start?
Where do you draw the line?
What do you covet?
What do you really _desire_ that is just beyond your grasp?
These are not things we often sit down and mull over, unless prompted.
I found "What I Covet" to be most challenging and revealing. There are any number of _things_ that Id really like to have, but when the thought of a real vacation occurred, I could feel my heart beat a little faster, my adrenaline begin to surge. I usually put desires like this far from my conscious mind because I know how unlikely they are to become reality, at least anytime soon. But all the same, we _must_ have something to dream about, something for which to strive. The mental pictures evoked by thoughts of a leisurely stroll through the cobblestone streets of a small Italian village, a vigorous walk up the winding staircase at the Basilique de Sacre-Coeur, an hour or two or four wandering the halls of any museum. For whatever reason, these images motivate me, give me that essential burst of energy, that ray of hope that there may be more to this than day in, day out, week after week. A peek into the future, if I can hold onto it and make it mine.
Im off to save the world, or at the very least a bunch of moms and babies!

Inspiration strikes! (finally.)
Well, ok. Shanetagged me, so Im more or less compelled to seek out the inspiration to write... but this was fun, and I look forward to reading others responses as well. Keep tabs on everyone whos been tagged for this meme at the Nursing Jobs blog.
I had to laugh while browsing through a few of the past "Things I Cant Live Without" articles on Inc.com, looking for that ever-elusive inspiration. The successful business owners who have been interviewed elaborate on the objects of value in their daily professional lives. They *cant live* without a whole lotta really expensive gadgets and gizmos. This is not what I had first planned to blog about when I imagined the most important aspects of my working world. I was thinking more along the lines of: I cant live without sleep, I cant live without the constant intellectual and emotional support of my co-workers, I cant live without hugs from my kids when I walk in the door...
In the interest of sticking to the topic, Ill conform to the heart of the idea. Im not sure I can narrow it down to just four, but then again, my "things" arent quite as extravagant as those Inc 500 folks, either. Keeping it simple and honest, here are the "things" that I cant live without:
DANSKO CLOGS $104.95
I heart my clogs. In all seriousness, I could not live without them, as my feet would likely go on strike. And with the miles I put on every night I work, this is not an option. I flirted with a few months of plantar fasciitis a couple of years ago, and dont care to be debilitated like that ever again. These clogs are awesome, durable, supportive, and best of all... blood and amniotic fluid-proof! They are worth the chunk of change.
At the same time, clogs and sterile blue scrubs are terribly bo-ring! Comfortable, but come ON. Its like wearing unflattering pajamas to work every night. So, I have about a gazillion pairs of fun socks, just to spice it up a bit, even if Im the only one that can see them. I know theyre there.
JOHNSONS SOFTCREAM EXTRA CARE HEALING HAND CREAM $4.79
The effect of washing your hands approximately 501 times every night? Hands that are raw, chapped, cracking at the knuckles, and peeling between the fingers. Argh! I love this lotion, and it works.
BANDAGE SCISSORS $3.99
I keep a pair of my own bandage scissors in the back pocket of my scrubs, and I use them constantly throughout the night. Who knew that something so rudimentary could be absolutely essential?
CLICKY PENS
Gotta love drug reps. Well, ok, not really. But I do love the pens that they leave lying around, usually transported to L&D in the pockets of the various docs that constitute a steady stream through the unit all day and night. I always like to have at least one "clicky" pen in my pocket... theyre more user-friendly and they dont go launching out of my pocket every time I bend over like the regular Bic ones do.
However, I was flabbergasted to find these pens _for sale_ on e-Bay. Hellooooo, people... theyre _FREE_!
CONFESSIONS ON THE DANCE FLOOR BY MADONNA $12.99
Ok, I admit it. Im a Madonna fan. I just cant help it. This CD gets me psyched up for working, working out, doing laundry, whatever. When Im not listening to NPR on the way to work, Im listening to this for a guaranteed burst of energy.
WHAT I COVET ...
A REAL VACATION. $$$ way-more-than-I-can-afford.99
Its been years. Ideally, Id love to take a trip to Europe. Doesnt even really matter where... England, France, the Netherlands, Italy, Spain. Id take any or all of them, preferably with ample time for mindless wandering, lots of picture-taking, exploring castles and cemeteries, visiting museums and lounging at charming cafes. Ohhhhhh...
WHOS NEXT...
I cant resist tagging Kim at Emergiblog. Shes one of my favorite bloggers, plus Im interested to see what "things" she cant live without!
JustCallMeJo over at Sinus Arrhythmia has an insightful and quirky take on the world of ICU nursing. What cant you live without, /jo?

Since embarking on this nurse blog journey, Ive noticed several changes in myself, both practical and philosophical. Perhaps these are changes that would have occurred in the natural evolution of my nursing career... Ill never know.
I am increasingly aware of issues about which I would never have given a second thought, and I have started to apply what Im learning at the bedside. Ive also found myself becoming more lucid and verbal in work-related situations which I previously would probably have either ignored or gone with the status quo. Lately, I look at nursing issues (and sometimes life as a whole) from a new and wider perspective.
Take some time blog-hopping, described here by the Curmudgeon. Or simply read through a few of the links on my sidebar. Youll see what I mean.
I have to conclude that reading up on the opinions and experiences of the other medical bloggers out there, and responding or at least pondering a response, has changed me. Perhaps not always for the better. I have to admit Ive been caught up from time to time, mindlessly lurking from one blog to the next, soaking up useless and sometimes utterly personal information from the multitude of blogs available.
However, if I peruse with a purpose (wink), sometimes I am struck with inspiration. To change my practice, adjust my attitude, or be called to action. All of which, I find, are stretching my limits and my yearning for growth and knowledge anew.
At times, I am also discouraged by what I read. I must confess that I am humbled by the bloggers whom I admire, those who write both prolifically and eloquently on a level to which I aspire. But if I stay silent until I measure up, this blog will lay dormant forever. It is those I seek to emulate who make me both afraid to click the "Publish" button and compelled to do so.
Speaking of my heroes, you can read Kims ideas for beginning nurse bloggers here. See what I mean? Witty, comprehensive, insightful? Check, check, and check.
Id love to hear how blogging has changed YOU... for better or worse. After all, this dialogue is what blogging is all about.
Or something.

Its never a good thing when a patient is called in, and everyone working triage groans. If all the nurses working know you by your first name:
A. Youve been here WAY too many times.
B. Clearly, you come in for unnecessary and frivolous admissions... and
C. You always get sent back home. (if there were really something wrong with you, youd _stay)_
We had a visit from a patient (lets call her Margo), who weve gotten to know very well over the past several years, now on her fourth baby.
Resident: "I have a patient coming in... its Margo ___."
Cacophony of disbelief from everyone within earshot: "Oh nooo... not again!"
Shes 32 weeks (a mere 8 or so more to go!) and only on her 9th admission to OB triage during this pregnancy, which, in comparison to her first pregnancy, isnt bad. With that child, she was on visit #36 by the time she finally delivered, and practically everyone who worked OB knew her name. Considering we only triage patients who are 20 weeks and up, thats more than a few visits per week. Back then, I remember caring for her two days in a row, both times for a slip and fall on icy pavement. Oh, Margo.
It never ceases to amaze me that she is willing to drag her husband and several small (screaming) children to the hospital in the middle of the night, through nasty weather because shes feeling some vague abdominal pain and general discomfort.
She actually told the person wheeling her up from the ER, "I really think its something serious this time... Im not kidding."
She was triaged and discharged back home with a clean bill of health within 45 minutes.
Until next time...

You know her. Shes the _labor-wannabe_. Lets call her Labor Girl.
******
Labor Girl arrives in the ER, breathless, cheeks flushed, anxious but elated. _This must be it_!
Her husband, lets call him Dear Hubby, parks the car and then joins her in ER triage, arms loaded with suitcases, birthing ball, boppy, radio and fan. He is a little panicky... a trickle of persperation slides from his upper lip. _What have I gotten myself into?_
But Labor Girl is thrilled. The deck of Uno cards is tucked into the front pocket of her suitcase, and a CD of soothing music resides in the portable stereo. _This is going to be fun!_
She is quickly retrieved from the ER and wheeled to OB triage, breathing obediently when her belly hardens. The babe inside her kicks in protest. She smiles knowingly.
******
Once she is safely ensconced in her tiny (if not somewhat unsatisfactory) triage room, she slowly strips out of the clothing she had carefully planned as her "going to the hospital" outfit. Dons the threadbare and breezy hospital gown, careful not to displace her perfectly coiffed hair and generously applied makeup. Pushes the call light.
Dear Hubby commences hand-wringing in the corner. Perhaps Labor Girl should share her deep-breathing techniques with him.
******
Soon the monitors are applied, blood pressure and temperature checked. Labor Girl dutifully answers the questions of the triage nurse, alternately smiling and breathing with the periodic tightening.

_"Well... Id rate these contractions about 6 or 7 on the pain scale." _Straight face. Its that darn pain scale again.
******
Bad news.
"_Im only dilated to 2 cm?"_
Labor Girl is clearly disappointed.
Doubt begins to curl around the edges of her optimism.
_"Are you going to send me home?"_
******
After a short while, the monitors are removed, and Labor Girl begrudgingly goes for a stroll. This isnt as _fun _as she had anticipated. Who wants to go for a walk at 2:30 in the morning? Another wave of doubt crests. _Maybe if I walk a little faster_.
******
Round and round she drags Dear Hubby, whose exhaustion has overtaken his fears.
The nurses smile understandingly each time the determined couple rounds the corner. Does Labor Girl think this is a race that she can win? That if she makes it through the hallways quickly enough or does enough laps, then well keep her?
******
Its time to be rechecked.
"_Yes_," Labor Girl nods to the nurse. "_The contractions feel much stronger_!"
She holds her breath, awaiting the verdict.
"_Im still 2 cm_?!"
******
And now, here it is: the Walk of Shame.
Poor Labor Girl.
She trudges out the doors, pouting, vistaril in hand. _How can this NOT be it?_
Dear Hubby gathers the belongings and follows her solemnly home. _Thank goodness this wasnt it._
******
And so, you see, sometimes no matter how badly you want it, labor it is not.
Maybe next time, Labor Girl.
Im sure well see you soon...

I want to form a committee.
I hereby volunteer to chair the Committee for Outlawing Committees that Accomplish Absolutely Nothing Except Wasting Valuable Time (COCAANEWVT). Anyone care to join me?
Seriously.
As a *lowly* staff nurse, I am subjected daily to the whims and wishes of upper management. Start a new type of charting starting by this deadline, go to this inservice on one of the above days, try to work amicably with nurses from postpartum when they need your help, dont forget your core ideals, have face-to-face conversations when you disagree with coworkers, make sure you pick up your shoes in the locker room... and on and on.
You might hypothesize that a good way to mitigate this problem would be to join one of the numerous committees that are dependent on staff nurse participation in order provide input and encourage change in the workplace.
If only it worked that way.
Despite the best of intentions, committees with which I have been involved rarely accomplish any tangible change. We spend hours brainstorming great ideas that should improve the flow of our work, the effectiveness of our communication, and the professionalism of our practice. But first we must delegate responsibility for each new concept to a subcommittee, survey staff as a whole to guage what kind of reception this change will receive, propose said idea to management for approval, and create posters and inservices so that everyone will know how to alter their practice.
Oh sure, we spend hours on implementation and evaluation of new ideas. We are congratulated by managers for our active participation in these processes. Thank you for all that you do to improve our unit, blah, blah, blah...
Does anything ever really change? No.
The finance committee has been hard at work. There are reams of paper lying around somewhere to prove that the new charging system in triage is more effective than the old one. Or were the papers used to disprove it? Who knows. And Im sure the new Good Job forms work infinitely better than the outdated ones. Good thing the central values committee spent weeks on that. Now, how can we solve the problem of inadequate staffing during peak scheduled procedure times? Lets send an OB tech to the recovery room to help and make the secretaries do baby baths. But wed better filter that idea down through the OB tech and secretary committees.
Last item on the agenda: the inconsequential issue of low staff morale and poor RN retention?
Lets pass that one on to the shared leadership committee. Im sure theyll have that one solved in no time.
Meeting adjourned.

And in sharp contrast to Labor Girl:
******
She rolled in by ambulance. Well, ok, the roads were a bit treacherous.
EMT: "23 year old female, fourth baby, term, her water broke about 20 minutes ago, she usually delivers an hour after her water breaks."
Ok.
Im getting her hooked up to the monitors, asking the usual questions...
Any health problems? No.
Any problems during the pregnancy? No.
Clear fluid? Yes.
Any bleeding? No.
Feeling the baby move? Yes.
Who is your doctor? I dont have one.
What?
_I dont have one._
You didnt see anyone during the pregnancy? No.
Not even one time? No.
Okie doke.
How do you know how far along you are? Im about 9 months.
Uh-huh.
Is there anyone on the way to be with you? No, my husband is home with our other children.
Oh my.
I said, "Its ok, honey. Were here with you." And I held her hand.
******
She did deliver a term infant about an hour after her water broke. Doesnt like doctors. Doesnt like hospitals. But my baby will be just fine.
And shes probably right.

Due to a severe case of Major Lack of Inspiration as of late, Ive been completely MIA. Im still here... and hope to be back in full force one of these days. The spring thaw will come.
******
In the meantime, Im honored to present the first non-blogger entry for the Nursing Jobs educational scholarships, totalling $5,000 and to be awarded March 31. Get your entries posted by March 19!
When Shane sent this essay out, offering to let one of us post it to our blog, I was immediately drawn to Sarahs story of courage and affirmation. It would seem that she has been "called" to the right profession. What an incredible nurse! Check it out:

WHY I CHOSE NURSING

by Sarah, LPN

Approximately 6 years ago, I was living in Raleigh, NC. I had a job in the mortgage industry, a "wonderful" husband, a beautiful home, two great kids, and thought I had it all. However, as it sometimes happens, the rug was pulled out from under my high-heeled shoes. My "wonderful" husband decided he wasn’t through dating other women and so we divorced. It was left up to me to provide for myself and my two children. Though I was making a 6-figure-a-year salary, I was quickly beginning to see that it isn’t always about the money. The stress of trying to take care of my children and make a living was catching up fast.

So, I turned to my high-school dream of becoming a nurse. It was a dream that I had pushed to the back of my mind when I decided to marry and start a family. But I could not pursue my goal, work, and take care of my children alone. So, I reluctantly left the city and returned to my childhood home in Arkansas - and to my family. My parents were such a great help in my pursuit of my RN. However, after 2 years of school, I realized that there was no way my children and I could continue without income. So I decided to take 11 months, get my LPN, and work until my children could graduate from high school. And that’s what I did.

I have always dreamed of being a nurse and now that I am, I realize even more that this is what I was born to do. I chose to work in the geriatric field because I feel a connection with the elderly and a need to protect the weak. I am in constant search of ways to make my residents feel useful and wanted. I can’t begin to describe the wonderful feeling of joy I receive from my job. Though my salary will never be as it once was, there truly is not enough money in the world to replace the feeling of satisfaction I receive in my work. I became a nurse because I want to make a difference. Now that I am an LPN, I want to continue my education and become an RN. I feel that as an RN I will have a greater effect on LPNs and other nurses. There’s a saying "give a man a fish and he’ll eat for a day- teach him to fish and he’ll never be hungry". I feel that this can be applied to my current situation. As an LPN, I can touch the lives of my residents only. As an RN, I can influence the LPNs who will touch so many more.
At times I can’t understand why any caring person would not pursue nursing. Then, at other times I see nurses that make me question why they would consider nursing. I feel that nursing is a profession that each person should be "called" to do. Being a nurse is not what you do – it’s what you ARE. And I can proudly say, I am a Nurse.

******
Good luck to you, Sarah. Its obvious that youll succeed in whatever path you choose.
N